Saunders NCLEX Questions

A client preparing to go home 2 days following a right mastectomy with dissection of axillary lymph nodes to treat breast cancer asks the nurse, "What should I do to minimize my chance for complications from this surgery?" Which response would the nurse make? "Try to minimize moving your right arm." "Examine the surgical incision once a week." "Be sure to carry your purse over your right shoulder."4 Avoid having blood pressures taken on your right arm."

"Avoid having blood pressures taken on your right arm."

A client is seen in the health care clinic, and a diagnosis of acute sinusitis is made. The nurse provides home care instructions to the client regarding measures that will promote sinus drainage and comfort. Which statement by the client indicates a need for further instruction? "I need to drink large amounts of fluids." "I need to use a cold mist vaporizer to liquefy secretions." "I need to try to sleep with the head of the bed elevated." "I need to apply heat, such as a wet pack, over the sinuses."

"I need to use a cold mist vaporizer to liquefy secretions."

The nurse has given a client with a leg cast instructions on cast care at home. The nurse determines that the client needs further instruction if the client makes which statement? "I need to avoid walking on wet, slippery floors." "I'm not supposed to scratch the skin underneath the cast." "It's okay to wipe dirt off the top of the cast with a damp cloth." "If the cast gets wet, I can dry it with a hair dryer turned to the warmest setting."

"If the cast gets wet, I can dry it with a hair dryer turned to the warmest setting."

A client with a history of heart failure is due for a morning dose of furosemide. Which serum potassium level, if noted in the client's laboratory report, would be reported before administering the dose of furosemide? 3.2 mEq/L (3.2 mmol/L) 3.8 mEq/L (3.8 mmol/L) 4.2 mEq/L (4.2 mmol/L) 4.8 mEq/L (4.8 mmol/L)

3.2 mEq/L (3.2 mmol/L)

A fasting blood glucose screening test is performed on a pregnant client. The results indicate that the blood glucose level is 140 mg/dL (8 mmol/L). The nurse would anticipate that which treatment measure would most likely be prescribed next for the client? An oral hypoglycemic agent A 3-hour glucose tolerance test Humulin N insulin on a daily basis A sliding-scale regular insulin dose

A 3-hour glucose tolerance test

The nurse is developing a plan of care for a client receiving a nasogastric (NG) tube feeding. When formulating the plan of care, what would the nurse consider?

Aspiration is a concern with an NG tube feeding.

What elements are essential for the nurse to plan to address to be able to deliver culturally competent care? Select all that apply. Assessing the client's health preferences Having knowledge of various racial and ethnic groups Acknowledging personal misconceptions of various ethnic groups Diagnosing health conditions commonly seen within the ethnic group Recognizing that subcultures exist and that not every characteristic of the cultural group is present

Assessing the client's health preferences Having knowledge of various racial and ethnic groups Acknowledging personal misconceptions of various ethnic groups Recognizing that subcultures exist and that not every characteristic of the cultural group is present

The nurse is scheduling diagnostic tests for a client. Which of the diagnostic tests prescribed would be performed last? Barium enema Barium swallow Gallbladder series Oral cholecystogram

Barium swallow

A postoperative client has been placed on a clear liquid diet. The nurse would provide the client with which items that are allowed to be consumed on this diet? Select all that apply. Broth Coffee Gelatin Pudding Vegetable juice Pureed vegetables

Broth Coffee Gelatin

The client seen in the health care clinic has tested positive for gonorrhea. The nurse anticipates that which medication will be prescribed based on this finding? Acyclovir Ceftriaxone Azithromycin Penicillin G benzathine

Ceftriaxone

A client has returned to the nursing unit after an abdominal hysterectomy. The client is lying supine. To thoroughly assess the client for postoperative bleeding, what is the primary nursing action?

Check the client's perineal pad; then roll the client to one side to check for further bleeding.

A client with pulmonary tuberculosis (TB) is on airborne isolation precautions. Which item(s) is essential for the nurse to wear? Gloves only Fluid shield mask Gown, mask, and gloves High-efficiency particulate air (HEPA) filter mask

High-efficiency particulate air (HEPA) filter mask

A client with atrial fibrillation who is receiving maintenance therapy of warfarin sodium has a prothrombin time (PT) of 35 seconds and an international normalized ratio (INR) of 3.5. On the basis of these laboratory values, the nurse anticipates which prescription? Adding a dose of heparin sodium Holding the next dose of warfarin Increasing the next dose of warfarin Administering the next dose of warfarin

Holding the next dose of warfarin

The client with lung cancer and a right-sided pleural effusion seen on chest x-ray is being prepared for a thoracentesis. The nurse would assist the client to which position for the procedure? Supine position, with the head of the bed flat Prone, with the head turned to the side supported by a pillow Left side-lying position, with the head of the bed elevated 45 degrees Right side-lying position, with the head of the bed elevated 45 degrees

Left side-lying position, with the head of the bed elevated 45 degrees

The nurse is caring for a client with a nasogastric tube that is attached to low suction. The nurse monitors the client for manifestations of which disorder that the client is at risk for? Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

Metabolic alkalosis

A client with a gastric ulcer is scheduled for surgery. The client cannot sign the operative consent form because of sedation from opioid analgesics that have been administered. The nurse would take which most appropriate action in the care of this client? Obtain a court order for the surgery. Have the charge nurse sign the informed consent immediately. Send the client to surgery without the consent form being signed. Obtain a telephone consent from a family member, following agency policy.

Obtain a telephone consent from a family member, following agency policy.

A client is recovering from abdominal surgery and has a large abdominal wound. The nurse would encourage the client to eat which food item that is naturally high in vitamin C to promote wound healing? Milk Oranges Bananas Chicken

Oranges

The nurse creates a plan of care for a client with a cervical-uterine radiation implant. Which intervention would be appropriate for the nurse to include in the plan? Restrict all visitors. Keep the client's room door open. Place the client in a semi-private room. Place a lead shield at the client's room.

Place a lead shield at the client's room.

A client is being treated for metabolic acidosis with medication therapy and other measures. The nurse would plan to monitor the results of which electrolyte, which could dramatically decline with effective treatment of the acidosis? Sodium Potassium Magnesium Phosphorus

Potassium

The nurse is developing a plan of care for a client with late-stage Alzheimer's disease. The nurse identifies which client problem as having the highest priority? Risk for injury Social isolation behaviors Role performance alterations Inability to communicate verbally

Risk for injury

Which teaching method is most effective when providing health care instructions to members of specific populations? Teach-back Video instruction Written materials Verbal explanation

Teach-back

A client is about to undergo a lumbar puncture (LP). The nurse prepares to place the client in a side-lying position, with legs pulled up and head bent down onto the chest for which purpose?

To open the spaces between the vertebrae

The nurse is caring for an older client who had a hip pinned after being fractured. Which would the nurse do to prevent further injury? Respond to the call light within 10 minutes. Use a night-light in the hospital room and the bathroom. Medicate the client with a sleeping pill to encourage the client to sleep through the night. Keep all four side rails in the up position, preventing the client from getting out of bed.

Use a night-light in the hospital room and the bathroom.

The nurse is admitting a client who is suspected of having tuberculosis (TB) to the nursing unit. The nurse would plan to admit the client to a room that has which properties? Venting to the outside and ultraviolet light Ultraviolet light and three air exchanges per hour Ten air exchanges per hour and venting to the outside Venting to the outside, six air exchanges per hour, and ultraviolet light

Venting to the outside, six air exchanges per hour, and ultraviolet light

The nurse reviews the blood gas results of a client with atelectasis. The nurse analyzes the results and determines that the client is experiencing respiratory acidosis. Which result validates the nurse's findings? pH 7.25, Paco2 50 mm Hg pH 7.35, Paco2 40 mm Hg pH 7.50, Paco2 52 mm Hg pH 7.52, Paco2 28 mm Hg

pH 7.25, Paco2 50 mm Hg